It was a daily battle for Arthur Porter even to get to his front door. Towering piles of books, papers, magazines and shopping bags filled his hallway, and put much of the rest of his house out of bounds. Living without hot water and not daring to put on his gas fire because of all of the clutter surrounding it, Porter says he knew his hoarding had got out of control. "It had got to the stage where I was almost living my life like someone in the middle ages. I knew things couldn't go on as they were but I couldn't see any light at the end of the tunnel," he says.

It was only when the fire brigade was called out after his faulty cooker started smouldering that Porter, 63, a former accountant and teacher, began to get the help he needed. He was referred to Orbit Care and Repair, a home improvement agency that supports older and vulnerable homeowners. It helped him to release equity from the home in Whitley, Coventry, where he has lived all his life, to pay for home repairs, and to start clearing the clutter he has accumulated over decades.

"When I first went to visit Mr Porter he could hardly open the front door," says Cath Sharman, deputy manager of Orbit. "There were piles of stuff up to the ceiling in places. He would bring in shopping and forget he had bought it. Not just food, but electrical gadgets and books. The neighbours had put in an insurance claim and it turned out an overflow pipe was dripping down from one of the bedrooms he couldn't get into. He didn't have a workable kitchen and his health was suffering."

Despite TV programmes such as My Hoarder Mum and Me, and Obsessive Compulsive Hoarder highlighting the issue, there is a real lack of consistency in the support on offer. Yet without the right support, hoarders become increasingly reclusive, are often shunned by their neighbours and are threatened with legal action or, if they are tenants, with eviction. And there are serious safety risks from fires and vermin infestations.

"This is really managed at a local level and although there are people like Orbit doing very good work, the efforts have been piecemeal," he says. "We are trying to find ways of managing the problem more effectively. It doesn't do anyone any good to just go and clear a house on an enforcement basis, because the behaviour just manifests itself again and the issue doesn't go away."

The experience at Orbit suggests that the most severe cases of hoarding may be triggered by a traumatic experience such as a bereavement. Porter says the roots of his hoarding go back to his youth. "My dad was a clutterer and it just seemed natural to me," he says. It spiralled out of control once his father died, his mother went into a home for older people and he battled with depression, which went undiagnosed for years. Although mental health professionals recognised he had a problem with his home, he says he had just been told to sort out the mess himself, until Orbit came along.

For Brenda and Jack Smith, their hoarding escalated after they became mostly housebound because of ill health. They had spent years washing out of plastic buckets because their bathroom was unusable – but work on a new wetroom funded by equity release could not be carried out until Orbit had arranged for their home to be cleared.

"I accumulated clothes and I had about 60 pairs of shoes I'd never worn. If I saw something I liked I got it in all different colours," says Brenda, 70. "I think it's because when we were young we couldn't buy stuff, as we didn't have the money. So when you get a bit older and can start buying things, you go a bit mad." She gets emotional when she talks about the difference clearing her house has made. "Before, it was terrible – we couldn't manage and we were having falls because of how much stuff there was everywhere. The change has been lovely."

Sharman says many cases of hoarding go unreported for years because people are unsure of where to go for help, or sometimes are too embarrassed to ask. "We learned a lot with Mr Porter," she says. "When we got the council in to clear his house and a lot of people came in to take things away, it was horrendous for him. We learned you can't do it like that. These people have not died, they still live there and you have to do it at their pace. We have to build a rapport and get a relationship going."

Walking into the downstairs of Porter's house, only a few carrier bags and a couple of boxes bear witness to his hoarding issues. But he is still sleeping downstairs as there is more work to be done upstairs. "He's come a long way," says Sharman. "But he still needs support. It can be a long process."